Cholera . . . .by Eghosa Imasuen
In a previous article I ranted about the misuse of antibiotics in the treatment of diarrhoea. That was a prelude to a series of articles on the topic of diarrhoea and its many causes. This time I will talk about a specific cause of diarrhoea.
Cholera has been in the news recently. Last year, an outbreak in the northern states of Nigeria had pundits abusing our government, our health-care providers. How could they let this happen? In Naija? In 2010? Shame! For an outbreak that was quite effectively contained I feel these pundits were angry with the government for other reasons. The reaction was prompt. The drugs were delivered. Doctors are working overtime in these places. In another part of the world, Haiti’s recovery from last year’s tragic earthquake was shaken by the reaction of some of its people to the cholera outbreak there—they believe that the aid agencies brought the disease to the island.
Cholera is caused by a rod-shaped bacterium called Vibrio cholerae. It causes a severe diarrhoeal illness, with associated vomiting, severe dehydration, and abdominal pain. Symptoms may start suddenly and quickly, sometimes as little as five days after contact with contaminated food, effluent, or other patients. The diarrhoea caused by the disease is especially profuse—the classically described “rice-water stool,” so described because of the flecks of detached damaged intestinal bits that float in the stool. An untreated cholera patient may produce as much as 8-10 litres of diarrhoeal fluid in a single day. This massive efflux is the result of a toxin produced by the vibrio cholerae bacterium that compels profuse amounts of fluid from the blood supply into the small and large intestines.
The transmission of vibrio cholerae is via the faeco-oral route. This simply means that after an infected person, or a carrier stools, somehow this contaminates either food or water, and the person who drinks the water or eats the food ingests live bacteria. (Note: It doesn’t mean that someone defecated in another person’s mouth o.)
Oddly enough, cholera is rarely spread directly from person to person. And vibrio cholerae is found naturally in some shellfish and plankton, but remember that there exist toxic and non-toxic strains of these bacteria.
Now for the serious bit: although cholera can be a devastating disease, killing rapidly before treatment can even begin, its prevention is very straightforward: sanitation and common sense. Living in a country with advanced water treatment infrastructure and sewage systems helps, but so does listening to mommy when she says; wash your hands after poo-poo, boil your drinking water, etc.
- Sterilization: All materials that come in contact with cholera patients should be sterilized by washing in hot water using chlorine bleach if possible.
- Sewage: anti-bacterial treatment of general sewage before it enters the waterways or underground water supplies helps prevent undiagnosed patients from inadvertently spreading the disease.
- Sources: Warnings about possible cholera contamination should be posted around contaminated water sources with directions on how to decontaminate the water (boiling, chlorination etc.) for possible use.
- Water purification: Chlorination and boiling are often the least expensive and most effective means of halting transmission.
There is a cholera vaccine available. It is used to stop outbreaks from spreading, and to prevent spread to health workers.
Cholera treatment works on two main premises. One is to attack the disease-causing organism itself, the other is to prevent death via dehydration of the sick patient. Aha, so this is where those famous antibiotics – tetracycline, flagyl ad septrin – come in.
Cholera has traditionally been treated with tetracycline. Antibiotics shorten the duration and lessen the severity of the diarrhoea. But the mainstay of cholera treatment has always been fluid replacement. Not diarrhoeal stoppage o. FLUID REPLACEMENT. This is what saves lives. In most cases simple oral rehydration therapy with the generic proprietary brands of ORT solutions used judiciously will keep a patient alive until the disease runs its course. Where the person is very sick, we may upgrade to intravenous fluids.
Nursing care is also important. Cholera is a disease that destroys the dignity of its sufferers. You literarily shit yourself to death. I remember the sniggers in class when we were first shown a cholera bed in medical school. The bed had a hole in the middle, a funnel that emptied into a bucket. When we asked our professor why the beds needed holes he told us that the diarrhoea was so uncontrollable in the acute phase of the disease that patients did not have time to ask for toilet breaks or bed pans. And that as the epidemics worsened, nurses did not have time to respond promptly to every patient. Our professor warned us about the dignity of the patient. He punished those who sniggered at the beds with extra call duty.